Some of the most commonly reported foot injuries on the Appalachian Trail include plantar fasciitis, achilles tendonitis, and ankle sprains. While these conditions can indeed be problematic, there exists a plethora of information with which to reference and learn the various ways to recover. During my 2018 thru-hike, I successfully avoided these particular foot injuries yet fell victim to a sneaky and troublesome chronic injury called a bunionette, also known as a tailor’s bunion.
Bunionette – The Bunion’s Wicked Stepchild
Cedars Sinai describes a bunionette as, “similar to a bunion, but occurs on the outside of the foot. It is a raised portion of skin that often becomes irritated and sore”. Although less common than traditional bunions which appear near the big toe, bunionettes can be just as painful and disruptive to someone who is on their feet all day (e.g. a thru-hiker). Bunionettes are also known as “tailor’s bunions” because the clothing tailors of yesteryear commonly sat cross-legged with the outsides of their feet rubbing against the ground, causing bunionettes to form.
Bunionettes are caused by pressure and trauma to the outside of the foot as a result of poorly-fitting shoes, arthritic conditions, or misalignment of the metatarsals (toe bones). They typically develop gradually and worsen over time, getting more painful and swollen as the condition continues and the body reacts by adding bone, further exacerbating the effect. Thru-hikers are particularly susceptible to tailor’s bunions because of the shock and damage that their feet are experiencing on a daily basis for months on end.
Treatment of bunionettes typically doesn’t require surgery, although it’s an option if other fixes don’t work. Non-surgical treatments involve changing shoes to a pair that have a wide toe-box (e.g. Altras), wearing sandals, or applying some kind of pad or cushioning to soften the impact. In some extreme cases, surgery can be used to realign the metatarsal or shave down extra bone that has accumulated.
My Story
Before hiking the AT, I had run a handful of ultramarathons and was already a proponent of Altra shoes. I never experienced foot pain during any of my training or races, so I figured I had my footwear dialed in. I started the trail wearing a pair of Altra Timps, which I had used to set the FKT for a little-known trail on the island of Cyprus just a couple of weeks before and they felt great. However, by the time I reached Damascus, VA they were toast and I was having some worrisome IT band issues that had me second-guessing my shoes. I switched to a pair of Oboz Sawtooth hiking shoes, which didn’t work for me at all, and soon after began feeling the bunionettes worsen as the stiff sole wore down my newly-formed callouses.
The pain was gradual at first, but after a couple of weeks it would be excruciating within just a mile or so of walking in the morning. Not knowing what was causing the irritation, Googled my symptoms and discovered bunionettes. I started taking ibuprofen a couple of times per day, which I hated having to do since everything else felt great, but it helped. As time and miles went on, I ended up switching shoes three more times in an effort to provide some relief to the swollen and inflamed abscesses.
The shoes I ended up finishing with were the New Balance Kaymins, which were the only pair of trail shoes I could find in a wide size. Although I missed the zero-drop and foot-form features of my beloved Altras, I tried a couple of pairs on and they just weren’t wide enough for my bloated feet. If I went up in size any more they’d become too long and unwieldy, so I needed to go with something that had a wide base all the way through rather than just at the toe box.
By the time I switched to the extra-wide Kaymins in Hanover, NH, my bunionettes were beyond help. Even with the extra space, the impact of the roots and rocks of New England eviscerated them more and more, to the point where I was taking 800mg of ibuprofen per day just to put in average miles.
In addition to swapping shoes and taking ibuprofen, I also tried using some silicone bunionette pads which I hoped would add a bit of cushion to the area and reduce pain, but unfortunately their flimsy design didn’t keep them in place and within a mile of walking they’d pads would be twisted and tangled inside my shoes, usually ending up on top of my foot rather than on the side.
In the end, the only fixes for me were to have an extra-wide shoes and take ibuprofen religiously. My feet hurt all day, every day, and I don’t think I could have put up with it much longer. More than food or rest, I was most looking forward to foot comfort after finishing.
After the Trail
Once I finished my journey, I immediately took a week off with almost no physical activity. My feet stopped hurting and I didn’t take any more ibuprofen. My bunionettes, however, didn’t go away. I started doing some light running a couple of weeks later and could feel them throbbing after a handful of miles, but it was nowhere near the level it was during the hike ((not walking around with a 25lb pack may have helped!).
A month after finishing the hike, the bunionettes had improved but I nevertheless decided to go see a podiatrist to make sure there wasn’t something more serious going on that I needed to address.
The podiatrist took some x-rays of my feet and while he was able to confirm that I hadn’t crippled myself, there was a slight calcification on my left pinky toe that the doctor said was probably the cause of some pain.
The doctor also measured the angles between my metatarsals and said they aren’t too askew, so he didn’t have any major concerns with the condition of my feet. We discussed treatment options for the bunionettes and he recommended Altra shoes (go figure) and perhaps a shoe stretcher that could help widen the shoe further. He noted that the zero-drop feature on Altras can help take some of the pressure off my forefoot that is normally applied with a higher-drop shoe since it shifts the impact of the step to the middle of your foot instead of the front. If Altra made extra wide shoes that could accommodate these behemoth growths, I’d be all for it. Unfortunately, their newer models seem to have a slimmer body and so I’m not sure they’ll work for me. Until the swelling permanently decreases on my bunionettes, I’ll continue wearing wider shoes to alleviate some of the discomfort.
Summary
Bunionettes, aka tailor’s bunions, are swollen lumps that appear on the outside of the foot and are caused by restrictive footwear and/or misalignment of the metatarsals. If not treated, they can become extremely painful and a real burden while attempting to thru-hike. Mine formed after the first 400 miles and worsened until I was medicating the pain away for the remainder of my hike. Although I was very happy with my daily mileage, the bunionettes had a negative impact on how well I felt throughout the day.
After seeing a podiatrist at the conclusion of my hike, I found out that I didn’t have many treatment options aside from surgery and shoe modification to provide relief. At this point, I’m not ready to go under the knife and will instead focus on pain mitigation through wider shoes and more rest. I’m hoping to train for another ultramarathon early next year, and my recovery from this and the AT in general will likely dictate the possibility of that endeavor.
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Brandon Chase is a writer, endurance athlete, and guide based in Maine. He is a former Foreign Service Officer with the U.S. Department of State and spent nearly a decade overseas serving at embassies in Egypt, Cyprus, and Pakistan.
Along with a 98-day thru-hike of the Appalachian Trail, he has summited Mt. Kilimanjaro, hiked the West Highland Way, fastpacked in the Himalayas, and trekked around New Zealand and South Africa. He also regularly competes in ultramarathons at the 50k, 50-mile, and 100-mile distances. He is a Lead Guide for Andrew Skurka Adventures and the New England Outdoor Center.
So, did the shoes help?
They did, slightly. By the time I adjusted to the New Balance shoes my feet were already in quite a bit of pain, but having extra space helped to relieve pressure from the sides. Today marks three months since I finished the trail, and I’m just now able to wear regular shoes again!
Cool. Are you able to currently run/hike without pain?
Yep! Totally pain-free now.
So, by “totally pain-free”, do you mean that the bunionette has gone away?
About a week ago, I just began exhibiting symptoms of tailor’s bunion. It isn’t painful, but it is uncomfortable. It feels as though something on the outer edge of my foot is out of place (…From what I’ve read, I guess that would be the metatarsal?)
I’ve just discovered what this is and have become really depressed about it. I’m hoping that there’s enough time to do something about this condition without having to resort to surgery.
@Andrew – the bunionette hasn’t totally gone away, and I doubt it ever will. However, by taking some time off after the hike and getting some wider shoes (I went up a full size and switched to Topo shoes), I was able to get rid of almost all of the discomfort. Although I have run multiple 50km+ ultramarathons since without issue, they do occasionally get tender – although not to the levels they once were.
I suggest you give Topos a try and also consider Yoga Toes to help correct your metatarsal issue before going the route of surgery. Best of luck!
Ugh. I’m dealing with this myself. I started feeling it last summer about 6 weeks out from an Ironman race. It settled down with less running after the race but with my training ramping up for another one in 10 more weeks, the run has become agonizing.
Had to put inserts in my cycling shoes to alleviate the pressure and was successful but still can’t find something for the run. I wear the Hoka Bondi in wide and even that stops doing the trick. Perhaps it’s worth giving Altras a shot?
Dani,
Sorry to hear about your struggles with bunionettes. They are very sneaky and surprisingly painful to deal with.
I suggest giving Topo Athletic shoes a try, as they offer a wide toebox as well as a low-drop insole and both trail and road models. If you are used to traditional high-drop shoes, going straight to Altra’s zero-drop might cause some issues, especially if you’re in the middle of your training. I’ve found Topos to be high quality and well-fitting in the last year that I’ve been wearing them exclusively.
Best of luck!
Thanks for the article. I too suffer from a tailors bunion on my right foot. Mine got to the point to where I cannot even have a shoe on without pain. I can walk on Altras if I am wearing correct toes (similar to yoga toes). My 5th meta was pretty far off from normal so I opted for surgery. I having it in two days which is why I’m googling away last minute. I’ll let you know how it goes.
Hi Nathen – thanks for the insight and sorry you are suffering so badly from this. Please do let me know how the surgery goes!
Hi Brandon! Thank you for the insightful article, I am also dealing with Bunionettes. I have found tape to be effective at preventing pain, I’m currently using Nexcare Waterproof Tape and I’m wearing Wide Saucony Cohesion (I may need to try athletic tape and XW running or trail shoes). The tape actually offers great protection for the bunionette and it does not come loose 😉 – would you consider using medical or athletic tape?
What has been your experience with Yoga Toes, or other toe stretchers? Has your bunion soreness dissipated over time by using it?
Wishing you the best!
Hi Nathan!
Thanks for the tape tips! I have not used it before, but would definitely consider it for long hikes or ultramarathons. The soreness has definitely dissipated over time and I have used Yoga Toes off and on – not sure how much they have helped, if at all, but it makes me feel like I’m doing something to help.
One thing I have found helpful is to shave my calluses. After finishing the AT I had thick ones on the sides of my pinky toes (and other places), which become painful and can get blisters underneath. By shaving them down with a foot file it has relieved that pain quite a bit – and no more blisters!
Very true, I have also noticed that managing the calluses that form can help by trimming it down with an electric callus sander or pumice stone. Amazon offers a wide array of electronic Callus removers around $20 that are rechargable with lithium ion batteries.
Update: I have moved to waterproof Athletic tape as a better solution it stays on longer and can be layered as needed. I’m currently using Hampton Premium tape and it can stay on for 3 days to a week.
Great to hear! Have you tried Leukotape? I find that to be incredibly durable as well as breathable.
Hi Brandon – I think I’ve got a mild but chronic case of bunionette on my left foot. It feels like a sharp pain exactly on the outside (of the foot) point where the 5th metat. connects with the small toe. Give the foot rest and pain is almost gone. First mile or so of a slow run and the sharp pain seems to be almost not noticable but you know it’s there so I ice after every run.
I believe it was my running shoes combined with low heartrate slow runs for months. Most probably there’s a running form issue on my part, which I’m trying to address too.
I started with Brooks neutral shoes (and Brooks is a great shoe but a 12 mm drop) when I got this pain. I switched to Saucony Ride 13’s with a slighlty wider toe and an 8 mm drop and I immediately noticed less pain. Now I’m no Altra Torin 4.5’s Plush and they’d great. Pain is still there some mornings on the run, but only for the first mile or less.
I assume from your recovery experience it can take a couple of 3 or more months to get past any daily bunionette pain (so patience and you should progressively see daily runs be a little more pain free)?
The other question is do you do any preventitive foot (and leg and heip) exercises to ‘stay foot healthy’?
Many thanks
David,
Sorry to hear about your foot issues! Have you gone to see a podiatrist? I would recommend doing so to get an x-ray and make sure it’s a bunionette issue and not something worse like a broken toe that keeps getting aggravated.
As I mentioned in another comment, the best things I have found to deal with bunionettes are: rest, wide toebox shoes, managing calluses, and tape. As far as keeping foot health, I like to do single-leg balancing exercises that strengthen tendons around the ankle (on flat ground or a Bosu ball).
Thank you so much for this post Brandon! What model of Topo do you recommend? And any particular style of taping?
My pleasure, Mollie! I really like to Topo Ultraventure and Terraventure models – they fit me very well and may work for you too. As for taping, I will generally wrap a piece of Leukotape around the outside edge of my pinky toes to prevent excess rubbing which can exacerbate the bunionettes. I also shave my calluses regularly which keeps down the irritation as well. Hope that helps!